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Policies and Procedures

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tension_on_the_wire - 28 May 2008 03:35 GMT
I am curious to know what is happening out there in other veterinary
clinics than our cat's.  When it is time for a simple invasive
procedure to be done in your clinic, such as a blood draw, or a
bladder puncture, are cat owners/parents permitted in the room with
the cat or is the pet taken away by the staff and brought back to you
later.  Have any of you been denied your request to be in the room
with a particularly sensitive cat?

Thanks in advance

--tension
Matthew - 28 May 2008 03:45 GMT
>I am curious to know what is happening out there in other veterinary
> clinics than our cat's.  When it is time for a simple invasive
[quoted text clipped - 7 lines]
>
> --tension

I think it is up to the vet office.  I know a lot of people are not used to
the "rough" handling of their furballs.  My past vet; who just retired. I
told right up front that I am in the room with them if that is a problem I
will go elsewhere
MaryL - 28 May 2008 04:11 GMT
>I am curious to know what is happening out there in other veterinary
> clinics than our cat's.  When it is time for a simple invasive
[quoted text clipped - 7 lines]
>
> --tension

Different vets have different policies.  The first time I took Holly and
Duffy in for blood draw, my vet simply took one at a time into the lab and I
stayed in the examining room with the other cat.  That time was dreadful!
It took an inordinately long time (each cat) to draw blood, and I could hear
them screaming.  This was with a vet who is very knowledgeable and gentle.
The next time, I said I wanted to go into the lab with them.  My vet had no
objection -- and later said he was glad I had done that.  With me in the
room, each of my cats remained calm and the vet was able to do the whole
procedure in just a matter of a few minutes.  There was no pain.  I knew
enough not to talk or interfere, but my presence seemed to have a calming
effect.  I do think it depends on your demeanor and your relationship with
your cats, but I will never again permit my cats to be taken back to the lab
unless I accompany them.

MaryL
Dale Atkin - 28 May 2008 04:44 GMT
>I am curious to know what is happening out there in other veterinary
> clinics than our cat's.  When it is time for a simple invasive
[quoted text clipped - 7 lines]
>
> --tension

Depends on the animal, the vet, the owner and the proceedure. Some things
owners are allowed to be there for, others not. In some cases, the animals
will behave better without Mom/Dad there, vs with them there. Also, there is
the concern of how the owner will behave with 'Fluffy' undergoing the
proceedure (its one more thing for the staff to have to worry about). I read
a report from a vet once where someone snatched their animal away from the
needle while the animal was being euthanized, causing great distress to the
animal, the owner and vet. That vet no longer allows family present during
euthanasias. Other less extreme examples are things like hightened stress
levels in the room, which can be passed on to the animal.

Sometimes staff just get the feeling that having the owner around might not
be the best idea, and so may ask the owners to leave the room.

None of this is to say that the owner in the room can't be a benefit, but
just that sometimes having family there may not be the best thing for the
animal.

If you've been denied your request to be in the room with your pet, by all
means, I'd encourage you to ask why, but be prepared to listen to the
possible reasons, and accept that the staff might possibly be right.

Dale
tension_on_the_wire - 28 May 2008 06:09 GMT
> >I am curious to know what is happening out there in other veterinary
> > clinics than our cat's.  When it is time for a simple invasive
[quoted text clipped - 31 lines]
>
> Dale

Yes I am well aware of those issues and have already discussed it in
detail with our vet.  I too have never been denied access to my
animals during procedures until my current vet, primarily because most
clinics were comfortable with the idea that there is no procedure they
ever do on a cat that I have not had to do on a child or newborn baby
(pediatric intensive care doc) and therefore had a professional
armamentarium of my own to deal with a squirming feline which was at
least as competent as any clinic staff.

The current vet, however, who is excellent in all other respects, has
had to plead helplessness to change the policy of a clinic that he
does not own and is not a partner of and can therefore not change the
policy on that matter.  We came to an amicable agreement that I would
search elsewhere for this reason with the understanding that it was
not a reflection upon my opinion of his own performance and all is
fine.  However, we are having difficulty with finding an acceptable
replacement, and the cat in question is on twice daily methimazole for
severe hyperthyroidism, we are running out of meds and we are feeling
rather abandoned.

The last visit to vet was last July during which visit they took her
away, again against my wishes, and took her blood, with my permission,
and then proceeded to tap her bladder despite my very explicit request
that they did not do that to her.  The tech blithely and cavalierly
handed her back to me telling me what she had done because she could
palpate a full bladder anyway and thought she should.  The result of
that was that my cat, who had run with another feral cat of mine
outdoors for five years and was extremely sensitive, ran and was lost
to physical handling by me for almost the whole of the last year.
During that time, she had so lost trust in me over that incident that
my 15-year-old cat whom I had raised from kittenhood bit clear through
the joint of my big toe causing Pasteurella multocida deep-tissue
cellulitis that left me almost bedridden for two months.  I am only
just now beginning to earn her trust again and it is feeling as if I
were taming a feral cat from scratch which she never was.

So my original post was to test out the waters as far as other
people's experiences, in trying to decide whether I should go back and
attempt once again to negotiate with the office manager or actual
partners of the clinic.

Thanks for the input.

--tension
Dale Atkin - 28 May 2008 21:19 GMT
>Yes I am well aware of those issues and have already discussed it in
>detail with our vet.

Ok, sorry for babbling on ;). I made some assumptions from your OP that I
shouldn't have. My appologies.

>I too have never been denied access to my
>animals during procedures until my current vet,

>The current vet, however, who is excellent in all other respects, has
>had to plead helplessness to change the policy of a clinic that he
>does not own and is not a partner of and can therefore not change the
>policy on that matter.

Assuming he's not lying to you, that is just so wrong. I would think that
should be at the vet's discretion, not at the clinic's. Anyone out there
know if this is typically clinic policy, or the vet's own preference? I
don't see why the clinic should have a policy like this, that the vet isn't
allowed to overule.

>So my original post was to test out the waters as far as other
>people's experiences, in trying to decide whether I should go back and
>attempt once again to negotiate with the office manager or actual
>partners of the clinic.

I'd talk to the practice owner. With your experience in pediatric intensive
care, there is no reason that you shouldn't be allowed where ever your cat
goes (assuming you aren't a jerk :)! ).

Dale
Upscale - 28 May 2008 21:44 GMT
"Dale Atkin" <labrador1@ibycus.com> wrote in message
> Assuming he's not lying to you, that is just so wrong. I would think that
> should be at the vet's discretion, not at the clinic's.

You might feel that it's wrong, but all it takes is one lawsuit or the
threat of one to cause most any business to adopt rigid standards of
practice. Would you risk your entire business and livelihood by breaking
some rule of practice? Most people wouldn't.
tension_on_the_wire - 30 May 2008 04:36 GMT
> >Yes I am well aware of those issues and have already discussed it in
> >detail with our vet.
[quoted text clipped - 25 lines]
>
> Dale

Yes, I plan to, as it is worth going to some effort to keep this vet.
In point of fact, I have an appointment tomorrow with him so she can
at least be examined, and I plan to waive the bloodwork altogether
because I need her to have a few bloodless visits to desensitize her
before I let anyone poke her again.  I may as well do it at this
clinic as any other.  Meanwhile I will pursue the issue and see if I
can get someone to negotiate.

Many if not all of the explanations and arguments I've heard on this
thread have been given to me by the clinic as the reason for their
policy, but they do not really address the main issue which is one of
advocacy.  All the arguments are equally valid in human medicine, and
as another poster mentioned, the ER in particular is a good example of
a large area with multiple things going on and multiple patients and
drugs and Xrays everywhere and confidentiality issues (infinitely more
legally threatening) and yet, it is considered the nature of the beast
to learn how to handle that along with all the relatives and friends
who are in the ER with those patients, and all the parents who are, in
most cases, encouraged to stay with their children throughout even
some of the goriest procedures if they are up to it.  Even though we
know full well we can get more cooperation out of a child when his
parents are not there to complicate the situation emotionally, in many
cases, though not all.  The main reason for this permissive attitude
is that we must recognize the parents as the main advocates for their
children and therefore their right to be there.  I see no reason why
this should not be true for one's pets.

As to the potential lawsuits from animals biting their owners, no one
really wanted to take into account that the risk management issue
regarding an animal biting is not one-sided, as I found out to my very
real detriment.  The fact that it took place at home and not the
clinic isn't really relevant since any litigatious-minded pet-owner
would jump on the causation issue just as rapidly as an injury
happening onsite.  Fortunately for them that is not my aim.  I just
want to arrange a life for my cat of 15 years that is free of
unnecessary pain or terror.  It is the least I can do for her in her
declining years.  If getting bloodwork every six months to monitor her
hyperthyroidism is so traumatic it causes her to alienate herself from
me, and steer clear of everything including her medicine, then how is
keeping her alive in this fashion even justified?  She had the highest
thyroid levels this vet has ever seen, her electrolytes and thyroid
levels have been rock solid after treatment commenced two years ago,
and off meds, she would die a slow and painful death of wasting in
front of my eyes.  I can think of better ends for my Luthien.

Thanks for the input.

--tension
Suzie-Q - 28 May 2008 04:46 GMT
In article
<5b3780af-3b52-4ec4-95e6-d80fce0ca47b@w5g2000prd.googlegroups.com>,

> I am curious to know what is happening out there in other veterinary
> clinics than our cat's.  When it is time for a simple invasive
[quoted text clipped - 7 lines]
>
> --tension

My vet lets me go with the pet. One Sunday morning one of my dogs
was severely attacked by another. I took Rosie in on an emergency
and stayed in the "operating room" all the time the vet was doing
what he had to do to clean and stitch her up.

Any time I've said that I want to be with the dog or cat, I've
been allowed to.

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Sharon Too - 28 May 2008 14:21 GMT
>I am curious to know what is happening out there in other veterinary
> clinics than our cat's.

It's certainly up to each individual clinic. First off, not all procedures
are conducive to audience participation. It can be distressing to the owners
to see some things and the pet can be more wiggly when their humans are
around. Blood draws may seem minor, but - for instance- cats need to be held
a certain way for the neck to be shaved down and then the needle inserted.
If the owner doesn't know how to hold the cat or moved during the procedure,
it could be dangerous. Even off to the side, it's hard for them not to talk
to the cat to try to sooth them making the cat want to wiggle out of the
arms. Not good when a needle is being inserted into a neck vein.

Safety - there have actually been cases out there where the client has been
allowed to restrain their own dog and then was turned on and bitten. They,
in turn, sued the vet for 'allowing' the injury, and won. Some vets have
legal consents clients have to sign waiving rights to sue if they restrain
instead of staff.

In our case, the doctor decides. If it's done in the exam room, it has to be
a situation where clients would be there. If the pet is brought back to our
treatment area because of the need for help and/or equipment needed, the
client is not allowed for several reasons.

1. Safety - We need a trained staff member to do the holding. They go
through extensive training to learn how to hold animals of all shapes and
sizes so as not to injure themselves or the pet. Pets usually cry out not
from a needle stick but from the holding. It tends to piss them off! If done
properly, it's fast and safe.

2. Confidentiality - our treatment area is very large - much like a great
room in a house. It containes a lab to one side, the ICU on another, prep
area for OR  and radiology as well as tables for minor treatments. There are
other things going on there with cage cards listing owner names and other
confidential information as well as files around. We hold confidentiality
very high. IF we have a tour going on we'll flip the clip boards over and
grab charts, but we can't be doing this all day long. There are also
discussions going on regarding other cases, sometimes about clients'
financial situations and phone calls going on with clients. The staff
doesn't need to be looking over their shoulders all day and hushing their
discussions.

3. It's busy back there. It's no place for traffic as staff is going about
their business processing urine and stool samples, running blood work,
inducing and prepping animals for surgery, taking x-rays around the corner
etc. There may be bodily fluids being spilled on the floor or a wet floor
from just getting it mopped.

4. The staff works hard to keep it extremely clean and there are areas we
don't want stuff tracked back to. You'd be surprised what some people drag
in on their clothes that is not conducive to a hospital facility.

5. In that area, our medications are double locked. They need to be
available for emergencies. We don't need all of our business on display.

Now, that doesn't mean we bar the owners from being around all the time.
It's a case by case issues. We never allow clients to restrain for
procedures - ever. But there are times if we know the owner that we'll let
them stick around if it's a quiet time. Over the weekend a blocked cat had
to be catheterized. The owner was an out of town tech and the doctor decided
that she was knowledgeable and calm enough to actually help. And on a
holiday, the treatment area was empty as well as the ICU (amazing). I've
also seen emergencies where the panicked owners made the situation far worse
for the animal. We do what we do to keep the patient and owner safe and we
protect our other clients and patients as well. Discretion is always key.
sighthounds & siberians - 28 May 2008 17:19 GMT
>>I am curious to know what is happening out there in other veterinary
>> clinics than our cat's.
>
>It's certainly up to each individual clinic. First off, not all procedures
>are conducive to audience participation.

I wouldn't call owner presence "audience participation".  I'm
fortunate in that my vets believe my animals are calmer in my
presence.  That may not be true for all owners, of course.  But we've
had vets and techs request us to be present for x-rays, etc. on our
shyer dogs.  Two of my dogs donate blood, and there is no way I'd
allow that to be done without my presence, nor would the techs want to
do it without me.  There have been numerous occasions when we've
accompanied our animals 'in the back' - but this is a relatively new
hospital and there is a lot of space.  I doubt my vets would ever stop
"allowing" owners to be present for euthanasia.  They do take animals
"in the back" for cystoscopies and blood draws on cats (but not dogs)
- can't remember any other instances offhand.  Because their policy is
to allow owners who do not interfere or otherwise hamper what's going
on to be present as much as possible, I don't mind those occasions
when they take the animals into the back without me.  

Mustang Sally
Dale Atkin - 28 May 2008 22:11 GMT
> >I am curious to know what is happening out there in other veterinary
>> clinics than our cat's.
[quoted text clipped - 8 lines]
> them not to talk to the cat to try to sooth them making the cat want to
> wiggle out of the arms.

Funny, that is one of the things we ask owners to do who accompany pets 'to
the back'. (talk to the animal, scratch brains/butts etc. generally distract
them from what is going on).

> Safety - there have actually been cases out there where the client has
> been allowed to restrain their own dog and then was turned on and bitten.
> They, in turn, sued the vet for 'allowing' the injury, and won. Some vets
> have legal consents clients have to sign waiving rights to sue if they
> restrain instead of staff.

Boy I'm glad I don't live in the states. Sueing the vet because your own dog
bit you geez. The only time I could possibly see this as a possibility is if
the owner was 'pressured' in to restraining their animal (in other words, if
the vet said "Here you hold him, and I'll draw blood". (although even that
is potentially pushing the limits of what I would call 'reasonable grounds'.

> 1. Safety - We need a trained staff member to do the holding. They go
> through extensive training to learn how to hold animals of all shapes and
[quoted text clipped - 13 lines]
> staff doesn't need to be looking over their shoulders all day and hushing
> their discussions.

I've often wondered about confidentiality, what the clinic is obligated to
keep confidential, what they choose to keep confidential etc. In particular
I was thinking in regards to tattoo logs and things like that. I mean if
someone finds my dog, I *want* the clinic to give out my information to
someone calling in, but many clinics won't (prefering instead to act as an
intermediate point of contact). I went so far as to e-mail the AVMA once (I
meant to e-mail the Alberta Veterinary Medical Association, but instead I
e-mailed the American VMA). Their response was that its generally regarded
as 'clinic's discretion', but its generally what ever is for the animal's
best interest.

> 3. It's busy back there. It's no place for traffic as staff is going about
> their business processing urine and stool samples, running blood work,
[quoted text clipped - 5 lines]
> don't want stuff tracked back to. You'd be surprised what some people drag
> in on their clothes that is not conducive to a hospital facility.

These both seem a little weak to me. Couple of reasons. If you're so busy
that one additional person, who is close their animal is going to be a
hazard, then you've got a real problem. As far as cleanliness, it seems to
me that the animal is just as likely if not more likely to track 'gunk' in
to the facility as the owner (not many owners come in smeared with feces
;)), and the dirty animal is likely to be somewhat correlated to a dirty
owner anyways.

> 5. In that area, our medications are double locked. They need to be
> available for emergencies. We don't need all of our business on display.

I agree with you here. The owner shouldn't be allowed to 'free range', but
at least in the clinic I'm at, I doubt anyone other than staff and
volunteers would know their way around the clinic well enough to quietly
take anything worth taking without being noticed.

> Now, that doesn't mean we bar the owners from being around all the time.
> It's a case by case issues. We never allow clients to restrain for
> procedures - ever.

I can certainly understand that. I prefer to let the person who's being paid
to be there to risk being bitten.

> We do what we do to keep the patient and owner safe and we protect our
> other clients and patients as well. Discretion is always key.

That to me is the key point, and what makes it difficult to tell via a
written conversation. If the vet gets the impression that the owner might be
a hinderance (owner judged likely to be flakey/disruptive/nuissance etc),
then they should be barred from 'participating', but I do think the vet
should be able to overule the general clinic policy if they so choose.

Dale
Lee - 29 May 2008 10:56 GMT
>> Now, that doesn't mean we bar the owners from being around all the time.
>> It's a case by case issues. We never allow clients to restrain for
[quoted text clipped - 11 lines]
> then they should be barred from 'participating', but I do think the vet
> should be able to overule the general clinic policy if they so choose.

I work in a (human) doctors' practice and once upon a time worked in an
ER. Just a few thoughts on this - the office could be asking for trouble
if they don't apply the rules equally. Otherwise they're going to hear
whining (and worse) that "you didn't let me go back with Fluffy, but you
let the lady in the next room". Trust me I REALLY understand the concept
of flakey/disruptive/nuisance family members (in our case) and how they
can get in the way; I'm just saying that I've also seen what happens
when families compare notes and determine they weren't given the same
perceived "privileges" as the next person.

And another thing I learned working in the ER in particular, is some
people tell you it won't bother them to observe or assist in a simple
procedure like a blood draw, and then they'll turn around and try to
faint on you! I'd imagine there is also concern about the practice's
liability in that case, because there is no doubt in my mind that if pet
owners cracked their heads, at least a few of them would try to collect
on it.
 
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